all of NURS216A/B

Medical use for Cannabis-- schedule

Schedule 1

High dose iron-- schedule

Schedule II

meds that contain Cough Syrup stuff (bc contains Codiene) & Cannabis for funzies --- schedule

Schedule III

Tylenol -- schedule

Unscheduled

Schedule I

MUST have PRESCRIPTION & drug must be provided by a pharmacist

- All Prescription drugs

- Drugs w no potential for abuse OR Narcotics('drugs W potential for abuse'= addictive)

- Controlled drugs (also r drugs that has potential for abuse)

- ex. Medical use for Cannabis

Schedule II

- available ONLY from a PHARMACIST('pharmacist rx('prescription')')

- retained in an area w NO public access

ex. High dose iron

Schedule III

- available via open access in a PHARMACY or PHARMACY AREA ('OTC')

- these drugs r Closed & off limits when the pharmacy closes

- *might be addictive if taken in BIG amounts

ex. meds that contain Cough Syrup stuff (bc it contains codiene), cannabis for funzies

Unscheduled

can be sold in any store w/o professional supervision (ex. Any convience store)

- ex. Tylenol

~25%

___ of PR('rectal') drug goes through 1st pass metabolism

Parental roa

'injectable'. ex. SC, IV roa

Enteral roa

'goes through GI sys'

<500 dalton

small. drug goes systemic

AC

'Before Meals'

PC

'After Meals'

QD

'Once Daily'

BID

'Twice Daily'

TID

'Three Times Daily'

QID

'Four Times Daily'

QHS

'At Bedtime'

QAM

'Every Morning'

QPM

'Every Evening'

QOD

'Every Other Day'

QH

'Once Every Hour'

Q2H

'Every 2 Hours'

Q3H

'Every 3 Hours'

PRN

'As Needed'

NPO

'Nothing By Mouth'

SC/SQ

'Subcutaneous'

Liver

25% blood flow at rest

Kidney & Muscles

20% blood flow at rest

Brain

18% blood flow at rest

Skin

7% blood flow at rest

Bone marrow & Heart

5% blood flow at rest

NARROW TI MEDS

- Digoxin (Lanoxin)

- Warfarin (Coumadin)

- Phenytoin (Dilantin)

- Tacrolimus (Prograf, Astagraf)

99% PPB drug

Warfarin (Coumadin)

Amoxicillin

drug class: Penicillin

travel UNCHANGED

- tx: Otitis Media

- roa: PO

- **combined w b-lactamase inhibitors (IF bac is resistant to 'this')

Grapefruit juice

Inhibits CYP3A4 (=> causes the enzyme to metabolize Lovastatin slower = slower Excretion of drug) => drug stays in body for longer => increased reduction of cholesterol)

Zero order elimination kinetic drugs

- Phenytoin (Dilantin)

- Ethanol ('alcohol')

- Aspirin ('ASA')

20mg/dL/hr

Clearance rate of Alcohol

CrCl calculation formula

normal Glomerular Filtration Rate

>59ml/min

4 x t ½

90% of the drug has cleared => u can administer more drug to the patient now

adenosine

enodgenous. Binds to receptor => makes u sleepy

- Caffeine binds to the same receptor as 'this' & causes an OPPOSITE effect(make u more alert) ('caffine is an INVERSE AGONIST')

Most common Toxicities

- ASA (Aspirin)

- Acetaminophen (Tylenol)

- Opioids (ex. Oxycodone, Fentanyl)

- Benzodiazepines (ex. Alprazolam (Xanax), Valium (Diazepam))

- Alcohol (ETOH)

- THC

- Cocaine

- +medication errors

ASA toxidromes

- Confusion

- Tachycardia

- Tachypnea

- Hyperthermia

- Diaphoresis

- Vomiting

Acetaminophen toxidromes

- Abdominal pain

- Loss of appetite

- Nausea/Vomiting

- Diaphoresis

- Somnolence

Opioids toxidromes

- Bradypnes/Apnea

- Bradycardia

- Somnolence/Coma

- Pupils CONSTRICTED

Cocaine toxidromes

- Agitation, tremors

- Tachycardia

- Tachypnea

- Hyperthermia

- Diaphoresis

- Pupils DILATED

Cannabis toxidromes

- Tachycardia

- Hypertension

- Seizures

- Nausea/Vomiting

- Acute psychosis

- Agitation; Coma

Activated Charcoal

tx via 'Adsorption'

- ENTERAL administration

- binds the drug to surface carbons => stops drug from getting absorbed => gets eliminated via Stool

- DOESNT work if u took the o.d drug a long time ago, since it prob already got absorbed into body

- tx drugs for": Tylenol, ASA, Benzodiazepines O.D

**doesnt work for alcohol overdose

Naloxone (Narcan)

tx drug for Opioid O.D

- ROA: intranasal, IV, IM, Subcutaneous

- onset: 2-4 min; duration of action: 45min

- ANTAGONIZES opioids from binding at mu & kappa receptors

Flumazenil

tx drug for Benzodiazepine O.D

- ROA: IV

- Flumazenil ANTAGONIZES GABA receptors

'n-acetylcysteine' (NAC)

tx drug for Tylenol O.D

- is a Glutathione enzyme presursor (=> enhnaces phase II metabolism)

*tylenol O.D (>4hrs): liver enzyme ('Glutathione') is depleted => casues low phase II metabolism => causes accumulation of hepatotoxic NAPB (product of phase I M)

Metadoxine

tx drug for ETOH intoxication

- ROA: IV

- induces('increases') alcohol dehydrogenase

**ETOH intoxication: causes depledted 'alcohol dehydrogenase'

Sodium Bicarbonate

tx drug for ASA O.D

- 'this' is BASIC (high pH) => IONIZES acidic substance(ex. ASA)

**acidic drug like acidic env (:. If in basic env, its molecular characteristic gets altered => increased Elimination)

**urine is naturally slightly acidic

Acetaminophen tx

tx Pain at CNS lvl

- Non-opioid centurally acting agents

- *NOT addictive

Opioids tx

tx Pain at CNS lvl

- centurally acting analgesics

*ADDCTIVE

NSAIDs tx

tx Pain at Peripheral lvl

- NON-Steroidal

*NOT addictive

Glucocorticoids (aka. Steroids, Coricoids) tx

tx Pain at Peripheral lvl

- Steroidal

Acetaminophen (Tylenol)

ANTIPYRECTIC, *NOT anti-inflammatory tho!

- CENTRALLY acting analgesic

- Administration: PO, q4h; pediatric: per kg

- HIGHEST efficacy for tx fever (bc 'this' is centurally acting: stimulates Hypothalamus => H causes peripheral Vasodilation => cooling)

- commonly used in Synergy tx (combining w other drugs)

Opioids

aka. Narcotics

- agonists for these CNS receptors: Mu, Kappa, Delta

- 'this' binding to receptor causes: increased Histamine & Dopamine release; Decreased Substance P & Glutamate (s&s: itchiness, addictive, slowed down & sleepy)

- mimics 'Endogenous opioid peptides'

Endogenous opioid peptides

r endogenous inhibitory neurotransmitters ("neuromodulators")

- includes: Endorphins, Enkephalins, Dynorphins

- released from: Hypothalamus, Limbic sys, Reticular formation

- all follows the DESCENDING ('efferent') pathway (=> then they bind to a receptor(meant for: opioids, serotonin, or norepinepherine) => inhibits release of Substance P (@where 1st && 2nd order neuron synapse w eachother))

Endogenous opioid peptides drugs

- Endorphins

- Enkephalins

- Dynorphins

High efficacy opioid:

- Fentanyl

- Hydromorphone (Dilaudid)

- Meperidine (Demerol)

- Morphine

- Methadone (Metadol)

Moderate efficacy opioid:

- Hydrocodone

- Oxycodone (OxyNeo)

- Oxycontin

- Tramadol (Ultram)

- Codeine

- combo drugs: Percocet, Percodan, Vicodin, Tramacet

Percocet

a Moderate efficacy opioid

- oxycodone + acteaminophen

Percodan

a Moderate efficacy opioid

- oxycodone + ASA

Vicodin

a Moderate efficacy opioid

- hydrocodone + acetaminophen

Tramacet

a Moderate efficacy opioid

- tramadol + acetaminophen

Codeine

a moderate efficacy opioid

- a prodrug (:. NO for kids (bc metabolism is too volatile('unpredictable'))

Tylenol #1

8mg codeine, 300mg acetaminophen, 15mg caffine

Tylenol #2

15mg codeine, 300mg acetaminophen, 15mg caffine

Tylenol #3

30mg codeine, 300mg acetaminophen, 15mg caffine

Tylenol #4

60mg codeine, 300mg acetaminophen, 15mg caffine

Non selective NSAIDs drugs

- Acetylsalicylic acid (ASA. aka. Aspirin) (has Enteric coasted ASA (ECASA))

- Ibuprofen (Advil, Mortin)

- Diclofenac (Voltaren)

- Naproxen (Aleve, Naprosyn)

- Ketorolac (Toradol)

- Indomethacin

Indomethacin

a Non selective NSAIDs

- 20x ASA POTENCY!!

- Prescription ONLY

Selective NSAIDs drugs

- Celecoxib (Celebrex)

Celecoxib (Celebrex)

a Selective NSAIDs (inhibits COX-2 ONLY)

- NOT 1st line tx

- Rx only

- rlly potent & has rlly bad s.e

COX-1

cause platelet aggregation

- 'this' activates Arachidonic acid into Prostaglandin

COX-2

cause pain & inflammation

- 'this' activates Arachidonic acid into Prostaglandin

if pain <4/10

=> NON-OPIOID medications

- PO

- probably ex. NSAIDS, Tylenol; synergy

if pain 4-6/10

=> OPIOIDS; combo meds

- PO

- synergy

if pain >6/10

=> HIGHER potency OPIOIDS

- PARENTERAL (ex. IV, SC...etc)

- consider PCA ('patinet controlled analgesia'): always given parenteral (usually IV); allows patient to choose when to receive med by themself

- synergy

Glucocorticoids

a STEROID drug

- Local or Systemic

- stimulates gluconeogenesis ('makes glucose')

- stimulates protein degradation (:. Too much cortisol => musc weakness)

- facilitates lipolysis (=> mobilizses stored energy)

- tx: Local, Chronic inflammation, Systemic disease, Chronic disease, (+ anaphylaxis)

Glucocorticoid drugs

- Prednisone

- Prenisolone

- Methylprednisolone

- Dexamethasone

- Hydrocortisone

- Cortisone

Dexamethasone

a glucocorticoid

- given for systemic inflammation d/t AUTOIMMUNE stuff (ex. IBD, Lupus, Rheumatoid Arthritis)

- give: PO, low dose, daily

- given as adjunct tx

Allergic Rhinitis tx

- Fluticasone (Flonase)

- Mometasone (Nasonex)

- Budesonide (Rhinocort)

Asthma maintenance drugs

- Budesonide (Pulmicort)

- Beclomethasome (Qvar)

- Fluticasone (Flovent)

diff types of Controller drug for asthma

- Glucocorticoids

- Leukotriene modifiers

- Mast cell stabilizers

Asthma rescue drugs

- Beta 2 Adrenergic Agonists (aka. "SABA")

- Antichholinergics

- Epinepherine

Beta 2 Adrenergic Agonists

aka. SABA

- a Asthma rescue tx

- binds to B2 receptor of SNS (=> B2 is located in LUNG :. BROCHODILATION)

Beta 2 Adrenergic Agonists drugs

- Salbutamol (ventolin, albuterol)

Antichholinergics

- a Asthma rescue tx

- inhibits PNS

Antichholinergics drugs

- Ipatropium (Atrovent)

1st generation Antihisamines drugs

- Diphenhydramine (Benadryl, Allerdryl)

- Chlorpherinamine (an ingredient in ex. Benylin)

2nd generation Antihistamines drugs

- Fexofenadine (Allegra)

- Loratadine (Claritin)

- Cetrizine (Reactin)

- Desloratadine (Aerius)

Cetrizine (reactin)

a 2nd generation Antihistamines

- fast melt tabs

- Onset: 10-20mins

- Duration: 24hrs

Prodromal stage

1/5 course of infection

- Initial s&s show: ex. Malaise, mild fever, headache, myalgia('musc pain')

- Generic in nature ('general s&s') :. hard to differentiate if bac or virus or wtv is causing the sickness

Convalescent period

1/5 course of infection

- pathogen DECREASING in numbers

- Progressive host repair of damages

Cell wall synthesis inhibitors drugs

- Penicillins

- Cephalosporins

- Carbapenems

- Bacitaracin

- Vancomycin

- Polymyxin B